national council of self insured employers max koonce sr. director risk management walmart stores,...

National Council of Self Insured Employers

Max KoonceSr. Director Risk ManagementWalmart Stores, Inc.

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Walmart Stores, Inc. is comprised of:

Walmart U.S. (approx. 1,400,000 associates)• 4,005 Walmart Retail Stores• 602 Sam’s Clubs• 142 Distribution Centers

Walmart International (approx. 800,000 associates)

• 6,148 Retail Units• 27 Countries

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The Walmart Property & Casualty Focus:

• Receive prompt and appropriate medical care that is focused on their recovery and return to gainful employment;

• Receive prompt and appropriate disability benefits;

• Compliance.

Workers’ Compensation

ensure associates that suffer work injuries:

• Addressed promptly and appropriately while recognizing the importance of our customers in the retail environment;

• Compliance.

General Liability Program

ensure all customers claims are:

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Flexibility

To ensure continual evolution of the program it must allow for:

Scalability

Sustainability

All tools must act as “enablers” to allow your property and casualty

program to pursue overall company objectives.

5 Casualty Reserve Review - Q1 FY15

Program structure allows Walmart to concentrate on our associates and customers through:

Self Administration

RMIS

Risk ControlProcess

Improvement

6 Casualty Reserve Review - Q1 FY15

Administering claims through our wholly owned subsidiary TPA helps ensure:

Appropriate claims management by: Data integrity:

• Accuracy

• Analysis

• Functional

• Owning the process

• Experience in best practices between in-house TPA and outside TPA vendors

• Compliance focus

• Direct relationship between operations and risk management

7 Casualty Reserve Review - Q1 FY15

Risk Control, although not part of our Risk Management Team, is an integral partner that

focuses on:

Accident prevention Safe place to work /safe place to shop

Accident investigation

Post accident support

Risk Control

8 Casualty Reserve Review - Q1 FY15

Process improvement involves:

Workflow process

improvement

Trend analysis

Coverage Decisions

Utilization of real-time data from all aspects to drive:

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• Are there additional resources needed for the claims management process?

• How do you best utilize the available resources?• At what point should resources be inserted into the

process?

Resource Allocation -

• What characteristics determine:• Claim exposure;• Claim difficulty;• Claim duration.

• Based on score, who should be managing the claim?

Claims Scoring -

Workflow Process Improvements:

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• What triggers indicate caution?• What path should be taken based on the triggers to

involve:• Greater in-depth investigations:• Additional external resources;• Etc…

Claim Triggers -

• Scoring Phases:• As the claim progresses score at different intervals

such as 90 day, 180 day, and 9 months.• Progression determines path of handling.

Complexity -

Workflow Process Improvements:

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• What characteristics determine outcome of the claim?• Return to work• Maximum medical improvement• Claim duration

• How should those characteristics be weighted as to impact on claim resolution?

• Determine physicians who obtain best outcomes for your injured employees.

• Where allowed by state law, select physicians who obtain the best outcomes for your injured employees.

Physician Modeling -

Workflow Process Improvements:

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• Property• Business Continuity Planning• Emergency Response Operations

• General Liability and Workers’ Compensation• Safety Objectives• Driving the APPROPRIATE behaviors

Exposure -

Trend Analysis:

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• Supplier Rating• What product do they provide?• What is the risk associated?• How is that risk going to be borne?

• Determine the Gap that is present in the coverage

• What should insurance package look like?

Product -

Coverage Analysis:

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In conclusion, our program structure:

Works with our business model

Ensures that we capture and

evaluate the data to drive improvement

Allows for optimum focus

on our customers and our associates